Individual
ELENA POTYLCHANSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
K4779
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042187702
—
TX
01
—
050062289
RR MEDICARE (MDACC)
TX
01
—
83187S
BCBS (MDACC)
TX
Enumeration date
10/17/2006
Last updated
06/19/2012
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